Provider Demographics
NPI:1972505394
Name:BARTLETT, KERRI A (DO)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:A
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX A D
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-1396
Mailing Address - Country:US
Mailing Address - Phone:530-751-3769
Mailing Address - Fax:530-751-1237
Practice Address - Street 1:555 FREMONT ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2534
Practice Address - Country:US
Practice Address - Phone:530-458-8635
Practice Address - Fax:530-458-7830
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E08841Medicare UPIN
020A48960Medicare ID - Type Unspecified